Facility Evaluation Report

Licensing Program Analyst (LPA) Kennedy made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself, and met with Leilani Baltazar-Charlot, administrator, and discussed the purpose of today’s visit.

A tour of the facility was conducted inside and out. LPA, accompanied by Ms. Baltazar-Charlot conducted a general overall inspection, with specific focus on infection control.

During today's inspection LPA observations include the following: Symptom screening procedures for staff, participants, and visitors; posted signs including visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; Hand hygiene practices; testing plan and procedures; plans for containing infections, PPE supplies procedures and training; and disinfection procedures.

Based on today’s inspection, no deficiencies were observed at this time in the areas evaluated. This report was discussed with Ms. Baltazar-Charlot. A copy along with Licensee Rights (01/2016) was emailed to Ms. Baltazar-Charlot. at the conclusion of the visit. An electronic response confirms the receipt of these documents.

Please submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-D to the licensing office within 10 business days . Forms available at www.ccld.ca.gov